External iliac artery dissection during kidney transplant for polycystic kidney disease : a caveat for surgeons

Abstract

Autosomal dominant polycystic kidney disease is a common cause of end-stage renal failure and an indication for transplant. The genetic mutation in autosomal dominant polycystic kidney disease also causes vascular abnormalities, mainly aneurysms but also medial dissection. Here, a case of dissection of the recipient artery during a kidney transplant procedure in a patient with autosomal dominant polycystic kidney disease is described. Dissection caused occlusion of both the external iliac artery and the donor renal artery. Occlusion was recognized intraoperatively, and the kidney was salvaged by in situ reperfusion of the kidney with cold preservation solution, excision of the affected recipient arterial segment, and reanastomosis of the donor artery to the internal iliac artery. The external iliac artery defect was replaced with a saphenous vein interposition graft. The transplanted kidney achieved good function. This is the first description of a case of recognition of recipient arterial dissection during a kidney transplant procedure for autosomal dominant polycystic kidney disease. Surgeons should be aware of the phenomenon of arterial dissection in autosomal dominant polycystic kidney disease and should be vigilant while anastomosing the artery during kidney transplant in these patients.